C.M. Blanchette

Changes in COPD demographics and costs over 20 years

Abstract Objective: Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death in the US and responsible for significant healthcare resource use. The purpose of this study was to examine the changes in COPD costs over 20 years and assess total direct cost trends over the last 10. Methods: A cross-sectional study of a population-based survey (2007 Medical Expenditure Panel Survey compared to the 1987 National Medical Expenditures Panel Survey) of respondents aged 40 and older with COPD (ICD-9-CM codes 491.xx, 492.xx, or 496.xx) was assessed for demographic and healthcare services use characteristics and compared to reported statistics from 1987. Ten-year trends in total direct medical costs from 1997–2007 are presented. Results: In 2007, there were 416 survey respondents with COPD compared to 228 in 1987. In 1987, women were only 39% of the COPD sample, while in 2007 they made up 58% of the sample. Mean cost per COPD patient was

Effect of Combination Fluticasone Propionate and Salmeterol or Inhaled Corticosteroids on Asthma-Related Outcomes in a Medicare-Eligible Population

16,135 (2007 dollars) in 2007, which was up from

Incidence and Cost of Ankle Sprains in United States Emergency Departments

11,807 (2007 dollars) in 1987 or a 37% increase. The proportional cost of emergency department visits (183%) and prescription drugs (170%) from 1987–2007 was high compared to other healthcare services. However, the mean cost of a hospitalization was the highest actual increase (

Cachexia among US cancer patients

2289). Ten-year trends show a similar gradual increase. Conclusions: The prevalence of COPD among females as well as the mean cost per COPD patient has risen sharply over the last 20 years. Cost-shifting from acute services to preventive services may allow US payers and healthcare providers to improve care and better manage costs for patients with COPD. More attention on prevention, diagnosis, and management needs to be directed to women at risk of COPD.

Moderate Symptom-Based Exacerbations as Predictors of Severe Claims-Based Exacerbations in Asthma

BACKGROUND National asthma treatment guidelines recommend either the use of inhaled corticosteroids (ICS) or ICS in combination with a long-acting bronchodilator for the treatment of moderate to severe asthma. Even though asthma is common among older adults, few studies have assessed the differences in effectiveness between these two recommended therapies in patients over 65 years of age. OBJECTIVE The aim of this study was to assess the association of the fluticasone-salmeterol combination (FSC) or ICS initiation on asthma-related events in Medicare-eligible asthma patients. METHODS This was a retrospective observational study using a large health claims database (July 1, 2001 to June 30, 2008). Subjects 65 to 79 years of age with 12-month preindex and 3- to 12-month postindex eligibility, an asthma diagnosis (ICD-493.xx), and with 1 or more FSC or ICS claims at index were included. Subjects with an FSC or ICS claim in the preindex and any claim for chronic obstructive pulmonary disease were excluded. Subjects were observed until they had an event (emergency department [ED] inpatient hospitalization [IP], combined IP/ED or oral corticosteroid [OCS] use) or were no longer eligible in the database, whichever came first. Cox proportional hazards regression was used to assess risk of an asthma-related event (IP, ED, or IP/ED). Baseline characteristics (age, sex, region, index season, comorbidities, preindex use of short-acting β-agonists, OCS, other asthma controllers, and asthma-related ED/IP visits) were independent covariates in the model. RESULTS A total of 10,837 met the criteria (4843 ICS and 5994 FSC). Age (70.4 and 70.5 years, respectively) and the percentage of female subjects (65.5% and 64.8%, respectively) were similar. Asthma-related events were also similar at baseline. Postindex unadjusted rates occurring after >30 days were ED (1.8% vs 1.5%, P = 0.18), IP (2.7% vs 1.7%, P < 0.001), and ED/IP (4.1% vs 2.8%, P < 0.001) for ICS and FSC, respectively. Subjects who received FSC were associated with a 32% (adjusted HR = 0.68; 95% CI, 0.51-0.91) lower risk of experiencing an IP visit and a 22% (HR = 0.78; 95% CI, 0.62-0.98) lower risk of experiencing an ED/IP visit. No differences were observed for ED visits (HR = 0.94; 95% CI, 0.68-1.29). CONCLUSIONS In Medicare-eligible asthma patients, FSC use was associated with lower rates of asthma-related serious exacerbations compared with ICS.

Effects of skilled nursing facility structure and process factors on medication errors during nursing home admission

Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range],

The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy.

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Hospital-based inpatient resource utilization associated with autosomal dominant polycystic kidney disease in the US

702-

Challenges in Research and Health Technology Assessment of Rare Disease Technologies: Report of the ISPOR Rare Disease Special Interest Group

1408] vs

Shared decision making and time to exacerbation in children with asthma

914 [